Provider Demographics
NPI:1689273856
Name:MOOR, JACLYN MARIE (AUD)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:MARIE
Last Name:MOOR
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2452 WATSON CT STE 1700
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-3216
Mailing Address - Country:US
Mailing Address - Phone:650-723-5281
Mailing Address - Fax:
Practice Address - Street 1:2452 WATSON CT STE 1700
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3216
Practice Address - Country:US
Practice Address - Phone:650-723-5281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU3276231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist